Severe Acute Neurotoxicity after Yohimbine Digestion in a Body Builder

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 46; no. 5; p. 394
• Main Authors: Giampreti, A, Locatelli, C, Petrolini, V, Lonati, D, Rocchi, L, Baldi, M L, Manzo, L
• Format: Journal Article
• Language: English
• Published: 01.06.2008
• ISSN: 1556-3650

Yohimbine is an alkaloid obtained from Corynanthe yohimbe and other biological sources (1). Yohimbine is used clinically in the treatment of certain types of erectile impotence (2) and has undergone a resurgence in street use as an aphrodisiac and mild hallucinogen (3). In recent years yohimbine has been very common in body-building communities for its hypothesized lipolytic and sympathomimetic effect. Objective: We describe a case of a bodybuilder in whom severe acute neurotoxic effects presented 1-2 hours after yohimbine ingestion. Case report: After ingestion of 5 grams of yohimbine mixed with niacin for a body-building competition a 37 year-old man presented early with generalized malaise, vomiting, loss of consciousness and seizures spontaneously resolving in a few minutes. At first evaluation the GCS was 3 so orotracheal intubation and fluids infusion were immediately started. At admission to the ICU the patient presented with hypertension (acme 259/107 mmHg) and tachycardia (acme 140 pulse/minutes) and was treated with furosemide and labetalol; chest radiographs and cranial CT scan were normal. The patient's history was negative for neurological diseases. An extensive gastric lavage was immediately performed, followed by oral administration of activated charcoal and cathartics. Twelve hours later the patient was extubated with normal hemodynamic parameters and neurological examination; he was discharged the following day. The yohimbine blood levels at 3, 6, 14 and 22 hours after ingestion were 5240, 2250, 1530, 865 ng/ml respectively. Conclusion: Yohimbine utilization in body-building communities is a known problem but few data are available about its toxicity and the related blood levels. The most common adverse effects due to yohimbine administration include antidiuresis, tachycardia, hypertension, vasodilation, nausea, tremor, irritability, dizziness, headache and hallucinations. This patient showed severe hemodynamic and neurological manifestations; to our knowledge it is the first case of intoxication with such high blood levels of yohimbine.